Arch Hand Microsurg.  2022 Jun;27(2):166-170. 10.12790/ahm.22.0007.

Extramammary Paget’s disease involving the bilateral axillae followed by adhesive capsulitis of the shoulder: a case report

• Bae SH
• Hong JH
• Kim RS
• Kwon SW
• Kim SH
• Park Hs
• Kim KE
• Kang T

• KMID: 2531924
• DOI: http://doi.org/10.12790/ahm.22.0007

Abstract

Few cases of bilateral axillary extramammary Paget’s disease (EMPD) have been reported. We performed surgical excision and reconstruction in a patient with bilateral axillary EMPD after consultation with dermatology. A dermatologist determined the boundaries of the lesion through Mohs micrographic surgery, and a plastic surgeon excised the lesion and reconstructed the resulting defect. Skin grafts were simultaneously performed to reconstruct the bilateral axillae. After the operation, the reconstructed site healed well, but the range of motion of both shoulders was reduced. After referral to a doctor specializing in rehabilitation, the patient was diagnosed with adhesive capsulitis and received additional treatment. Since no previous reports have presented a case of adhesive capsulitis after the reconstruction of bilateral axillary EMPD using skin graft, this case is noteworthy.

Keyword

Skin; Neoplasms; Plastic surgery; Axilla

Figure

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  Fig. 1. Preoperative picture showing extramammary Paget’s disease in the bilateral axillae. The patient visited our clinic with bilateral axillary erythematous brownish patches that had developed 1 to 2 years ago.

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  Fig. 2. Microscopic findings of extramammary Paget’s disease. (A, B) Hematoxylin and eosin-stained slides (A, ×100; B, ×400). (C) Immunohistochemical staining for cytokeratin 7 (×400).

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  Fig. 3. Posture of the patient maintained for 7 days after skin graft surgery. The patient maintained shoulder elevation and abduction with both hands above the head.

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  Fig. 4. Ultrasonography of the shoulder area performed 1 month after surgery. On ultrasonography, capsular thickening in the synovial capsular layer was confirmed, and adhesive capsulitis was diagnosed with physical symptoms.

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  Fig. 5. A photograph taken 3 months after surgery, showing successful healing of the skin grafts in both axillae.

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  Fig. 6. After 1 year of treatment at the Department of Rehabilitation Medicine, the range of motion had still not fully recovered.

Reference

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